High prevalence of gender based violence among adolescent female sex workers - need to improve access to health services

Prevalence and correlates of sexual and gender-based violence against Chinese adolescent women who are involved in commercial sex: a cross-sectional study.

Zhang XD, Myers S, Yang HJ, Li Y, Li JH, Luo W, Luchters S. BMJ Open. 2016 Dec 19;6(12):e013409. doi: 10.1136/bmjopen-2016-013409.

Objectives: Despite the vast quantity of research among Chinese female sex workers (FSWs) to address concerns regarding HIV/sexually transmitted infection (STI) risk, there is a paucity of research on issues of sexual and gender-based violence (SGBV) and the missed opportunity for sexual and reproductive health (SRH) promotion among young FSWs. Our research aimed to assess the prevalence and correlates of SGBV among Chinese adolescent FSWs, and to explore SRH service utilisation.

Design and methods: A cross-sectional study using a one-stage cluster sampling method was employed. A semistructured questionnaire was administered by trained peer educators or health workers. Multivariable logistic regression was conducted to determine individual and structural correlates of SGBV.

Setting and participants: Between July and September 2012, 310 adolescent women aged 15-20 years, and who self-reported having received money or gifts in exchange for sex in the past 6 months were recruited and completed their interview in Kunming, Yunnan Province, China.

Results: Findings confirm the high prevalence of SGBV against adolescent FSWs in China, with 38% (118/310) of participants affected in the past year. Moreover, our study demonstrated the low uptake of public health services and high rates of prior unwanted pregnancy (52%; 61/118), abortion (53%; 63/118) and self-reported STI symptoms (84%; 99/118) in participants who were exposed to SGBV. Forced sexual debut was reported by nearly a quarter of FSWs (23%; 70/310) and was independently associated with having had a drug-using intimate partner and younger age (<17 years old) at first abortion. When controlling for potential confounders, having experienced SGBV was associated with frequent alcohol use, having self-reported symptoms of STI, having an intimate partner and having an intimate partner with illicit drug use.

Conclusions: This study calls for effective and integrated interventions addressing adolescent FSWs' vulnerability to SGBV and broader SRH consequences.

Abstract [1]  Full-text [free] access [2] 

Editor’s notes: The paper reports a study conducted to measure the prevalence and correlates of sexual and gender-based violence among Chinese adolescent female sex workers, given the paucity of data on this. A cross-sectional survey was conducted in the Yunnan Province, which has a relatively high HIV-1 prevalence. Around 300 women aged 15-19 years, who had received money or gifts in exchange for sex in the past six months were recruited for a survey.

The survey revealed that over half the female sex workers were married or cohabiting but lived predominantly with other sex workers or friends, or alone. The majority reported that they had been a sex worker for less than six months. Over the past year, 82% of the female sex workers had an intimate partner, and most of these relationships were for less than one year. Alcohol use was common, with 83% of the female sex workers reporting drinking alcohol at least twice a week. Inconsistent condom use in the past month was reported by 57% of the female sex workers.

Around a quarter of women’s first sexual experience was forced. Thirty-eight per cent of the female sex workers reported having experienced sexual and gender-based violence in the past year, with three quarters of women reporting the perpetrator as their intimate male partner and (62%) a male paying client. The female sex workers experiencing sexual and gender-based violence in the past year were more likely to be frequent drinkers or have a drug-using intimate partner. Women who experienced sexual and gender-based violence were more likely to report unwanted pregnancy, and less likely to use public health facilities or HIV testing services.

The authors suggest that their findings reveal a missed opportunity for the public health sector to address sexual and gender-based violence and associated sexual and reproductive health issues. However, they suggested there is a need to involve women-led community-based organisations to build relationships with female sex workers to enable them to utilise such services. There is also a need for further research on integrated programmes to prevent or reduce sexual and gender-based violence against adolescent female sex workers. 

Epidemiology [4], Gender [5]
Asia [6]
China [7]
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